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` SAN sJ O A Q 11 IN Environmental Health Department <br />_ COUNTY <br />Greatness grows mere. <br />RETURN TO COMPLIANCE CERTIFICATION <br />Any MINOR violations noted in the "Notice to Comply' in the attached Inspect on Report must be corrected within 30 days of <br />receipt of this inspection This certification form must be submitted to the Environmental Health Department (EHD; address at <br />the bottom of this form within 30 days of receipt of the Inspection Report HSC 25404 1 2(c)(1) <br />All corrections to other violations noted in the attached inspection Report (IR) or Continuation Form or d sputes to any <br />violations, are to be submitted using this certification and returned to EHD within 30 days unless otherwise specified in the <br />Inspection Report HSC 25185(c)(3) <br />Note: All EHD staff time associated with failing to comply by the above noted dates will be <br />billed at the current hourly rate. <br />For this certification to be complete, the operator of the site must include: <br />A statement documenting what corrective actions were taken or will be taken for each violation <br />Copies of sample results/manifests/training recordslother appropr ate paperwork and/or photos verifying correct ons <br />Operator's certification <br />Inspection Date: October 10, 2019 Inspected By: <br />Facility Address: 2292 Daniels St, Manteca <br />certify under penalty of law that. <br />ELIANNA FLORIDO <br />CI=RS ID: 10664107 <br />1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned inspection date <br />2. 1 have personally examined the following do umentation submitted as proof of mpliance FOR EACH VIOLATION <br />and I believe the information to be true, a urate, and corn ete. <br />Photos Paperwork Statement <br />3. 1 am authorized to submit this certification on behalf of the Respondent. <br />4. 1 am aware that there are significant penalties for submitting false information, including the possibil-ty of a f ne and/or <br />imprisons nt for known �violations. (HSC 25191) <br />Name. (C n C. 1 '1 G Title: <br />Signature: / I /Date: <br />